OUR LADY OF ANGELS MISSION Authorization Form

General Permission
I request that my youth __________________________________be allowed to participate in the Corpus Christi Church trip to Our Lady of Angels Mission on April 6th, 2013. I hereby release and indemnity Corpus Christi Catholic Church of Carol Stream, IL, its staff, volunteer and the Joliet Diocese, from any and all liability arising from claims of any kind or nature whatsoever from my childs participation in this event. Videotaping and Still Photographs Video and still photographs may be taken during this event. This authorization form constitutes permission for my child's participation in the videotape and/or still photographs, which may be used for future promotional efforts, including the Corpus Christi Church website. Code of Behavior You are representing our diocese and parish. We expect that you will display a mature and responsible behavior, which is a trademark of Catholic youth. Expectations include (but are not limited to) those listed below: 1. All participates are expected to arrive on time. 2. All participants are expected to demonstrate common courtesy and respect al all times. Inappropriate language/behavior will not be tolerated. 3. Socializing should always be done in public areas. 4. Dress should reflect the value of modesty. Writing on clothing should reflect Christian values. 5. The possession or consumption of any alcoholic beverage, illegal drug or cigarette is not permitted. 6. Weapons and/or drug paraphernalia are not allowed 7. Infraction of these rules can mean immediate dismissal with no refund. MEDICAL PERMISSION FORM I grant permission for the administration of first aide to my child ______________________________ by the people in charge of the program and those transporting my child to and from the program as their judgment deems advisable and to make the necessary referrals to qualified physicians for treatment of illness or accidents of a more serious nature. I understand that I will be promptly notified in the event of any serious illness or accident and prior to any major surgery, except when delay in such communication would endanger life. In case of medical emergency, I understand that every effort will be made to contact the parents/guardians of the participant. In the event that I cannot be reached I hereby give permission to the physician selected by the adult staff to hospitalize, secure proper treatment for and to order injection, anesthesia or surgery if deemed necessary for my child. I understand and agree to this Behavior code. I also understand and agree that at the time of an infraction requiring my dismissal, I am responsible for my removal from the premises and any costs involved. If under the age of 18, I also understand and agree that my parent or guardian will be notified at the time of an infraction requiring my dismissal. My parent or guardian will be responsible for my removal from the premises and any costs involved. ____________________________________________________________________________________________ Signature of Parent/Guardian Youth Signature Date _________________________________________ Phone numbers where you can be reached during the event ___________________________________________________________________________________________ Authorized Physician Physician's Phone Number Please List any Medical Conditions or Allergies that we should be aware of:______________________________ ____________________________________ ________________________________________________ Insurance Company Policy in Name of: ____________________________________ Policy Number __________________________________________________ Subscriber's #

Please Circle how you may be available to serve:

Drive/Chaperone